Analysis: Kids health care plans on hold in Missouri

Sunday, December 6, 2009 | 4:56 p.m. CST; updated 6:44 p.m. CST, Sunday, December 6, 2009

JEFFERSON CITY —It's known as "Express Lane Eligibility" — an effort to put children on the fast track for government-run health care coverage.

But in Missouri, the Express Lane has become the slow lane.

Documents obtained by The Associated Press show the Missouri Department of Social Services recommended the adoption this spring of a half-dozen measures intended to enroll more children in government health care programs for low- and middle-income families.

With winter now approaching, none of those recommendations has been implemented.

"It takes money to do it," Gov. Jay Nixon explained last week. "With the downturn in the economy, we just have not had the resources to expand that area."

The expansion of health coverage was one of Nixon's chief campaign pledges last year. It will remain unfulfilled as he ends his first year as governor.

The Republican-led Legislature rejected the Democratic governor's proposals earlier this year to add more low-income adults to Medicaid and to expand the Children's Health Insurance Program by eliminating or lowering the premiums charged to families.

But when President Barack Obama signed legislation in early February giving states new ways to more easily enroll children in government health care programs, Nixon's administration quickly began working behind the scenes to take advantage of its provisions.

Within weeks, a top official in the Family Services Division of Missouri's social services agency had identified Express Lane Eligibility as "our best bet for rapidly increasing enrollment" in Missouri's health care programs, according to documents provided last week to the AP in response to an October open-records request.

Express Lane Eligibility allows states to assume that children already enrolled in other federal aid programs such as food stamps or child care also are eligible to receive health coverage under Medicaid or the Children's Health Insurance Program.

A March 26 department memo identified the sped-up eligibility effort as one of a half dozen options — labeled "Recommendation: PROCEED" — to increase enrollment in Medicaid and the Children's Health Insurance Program. To do everything would have cost the state more than $47 million. The result would have been nearly 42,000 additional people — mainly children — covered by Missouri's health care programs.

On Feb. 26 and again on April 16, Department of Social Services officials met with children's health care advocates to discuss options for expanding enrollment in health care programs. Following the second meeting, department director Ron Levy sent a memo to Nixon's staff indicating a strong consensus to "move forward on the express lane eligibility."

By the end of April, department staff had begun running computer tests to identify children enrolled in other aid programs who could be eligible for Medicaid. They also had developed a form letter to be mailed to thousands of parents.

But the enrollment letters never were sent.

Around that time, Missouri's tax revenues took a sharp turn for the worse. Nixon began the new fiscal year July 1 by announcing $430 million of budget vetoes and spending cuts.

Nonetheless, advocacy groups turned up the pressure on Nixon. They sent a letter signed by more than 50 individuals and groups urging him to direct the Department of Social Services to implement five specific steps to insure more children.

The timing couldn't have been worse.

The mid-July advocacy letter arrived the same week that the Department of Social Services warned Nixon's budget office that the Medicaid program likely would need an additional $35 million in state funds to avoid a shortfall during the 2010 fiscal year. One main reason: an expected enrollment increase of 37,000 children due to the poor economy. The department said there likely was some overlap between the newly enrolled children and those who would have been reached by the Express Lane Eligibility program.

But that hasn't made it easier for Nixon's administration to explain to advocates why it hasn't been able to follow through on Nixon's promise to expand health coverage for children.

"We're getting the crap beat out of us for not moving forward now on express lane enrollment ... which we need to do!" department director Levy wrote to his Medicaid division director, Ian McCaslin, on July 30.

Department spokesman Scott Rowson said Friday that the agency still wants to implement Express Lane Eligibility and other efforts to enroll more children in government health coverage. But he acknowledged: "It's probably not likely in the 2010 fiscal year," which runs through June 30.

Nixon also said he still supports efforts to expand government health coverage for children and the working poor. The governor said he's watching what becomes of the health care debate in Washington and monitoring the state's bank accounts.

"If we get an uptick and we have the resources to do it, you can rest well assured we'll be prepared to do it," Nixon said.

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Ray Shapiro December 6, 2009 | 5:14 p.m.

Children in Missouri have access to health care even if they do not have a government issued health insurance card.
Parents need to know this.
("Missouri Health Centers Serving
Low-Income Populations")

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